Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
[Rapid response system in derangement of vital signs: five years experience in a large general hospital].
Hospitalized patients are at risk for adverse events such as unexpected cardiac arrest or admission to an Intensive Care Unit (ICU). Prior to these adverse events these patients often have derangements in vital signs that are not recognized and treated adequately. To identify and treat those patients at risk, our hospital implemented a rapid response system in 2004. The purpose of this paper is to describe implementation and results of our rapid response system. ⋯ In our hospital the rapid response system has developed into an important tool for the early identification and treatment of patients at risk. However, our data cannot prove the efficacy of the rapid response system in terms of reducing hospital mortality.
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The publication of inadequately adjusted mortality rates has led to incorrect and unfair comparison of outcomes in quality of care between hospitals. In order to ensure adequate risk-adjustment of such outcomes, care providers should maintain their own registries. Such databases enable the monitoring and benchmarking of outcomes adjusted for case mix. ⋯ The goal of the database is to control and to improve the quality of care by providing frequent feedback to the participating hospitals about their risk-adjusted mortality rates. Other care providers should follow this example and register their own risk-adjusted outcomes. Such registries will function as a quality instrument and will provide an in-depth explanation of the oversimplified results that are often published.
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Ned Tijdschr Geneeskd · Jan 2011
Practice Guideline[Multidisciplinary guideline 'Heart failure 2010'].
In the multidisciplinary practice guideline 'Heart failure 2010', the diagnosis of heart failure relies on a combination of signs and symptoms and on supplementary investigation with natriuretic peptides and echocardiography. Once diagnosed, it is important to detect the potentially treatable cause of the heart failure. The non-medical treatment consists of lifestyle advice, of which regular body exercise is the most important component. ⋯ A restricted group of patients may require an internal cardiac defibrillator (ICD) and/or cardiac resynchronisation therapy. There is limited scientific evidence concerning treatment of patients with diastolic heart failure. It is important to coordinate the care of the patient with heart failure within a multidisciplinary team to provide optimal treatment and information for the patient.
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Ned Tijdschr Geneeskd · Jan 2011
[Scientific output of orthopaedic hospitals in the Netherlands: not all hospitals meet the requirements of the Dutch orthopaedic residency programme].
To evaluate the feasibility of the requirements for scientific participation in the Dutch orthopaedic residency programme by assessing the numbers of articles published by orthopaedic teaching hospitals. ⋯ Of the 29 teaching hospitals, 9 (31%) did not meet the requirements for publication specified in the Dutch orthopaedic residency programme guidelines. The number of published articles is related to the numbers of orthopaedic surgeons and PhD students in peripheral teaching hospitals. The requirements for the minimum number of publications could therefore be revised to reflect the proportion of orthopaedic surgeons in each teaching hospital. The introduction of a weighting factor that accounts for the quality of the publications would also result in a more balanced assessment.
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We admitted a 43-year-old comatose man with known liver cirrhosis and hyperintense subarachnoid spaces on brain CT, suggestive of subarachnoid hemorrhage. He died shortly thereafter. Autopsy did not show signs of subarachnoid hemorrhage, but revealed extensive cerebral edema. Pseudo-subarachnoid hemorrhage due to metabolic disturbances was diagnosed.